Abstract
BackgroundOver the past 40 years, the physician supply of North Carolina (NC) grew faster than the total population. However, the distribution of physicians between urban and rural areas increased, with many more physicians in urban areas. In rural counties, access to care and health disparities remain concerning. As a result, the medical school implemented pipeline programs to recruit more rural students. This study investigates the results of these recruitment efforts.MethodologyDescriptive analyses were conducted to compare the number and percentage of rural and urban students from NC who applied, interviewed, and were accepted to the University of North Carolina’s School of Medicine (UNC SOM). The likely pool of rural applicants was based on the number of college-educated 18-34-year-olds by county.ResultsRoughly 10.9% of NC’s population of college-educated 18-34-year-olds live in rural counties. Between 2017 and 2019, 9.3% (n = 225) of UNC SOM applicants were from a rural county. An increase of just 14 additional rural applicants annually would bring the proportion of rural UNC SOM applicants in alignment with the potential applicant pool in rural NC counties.ConclusionsOur model of analysis successfully calculated the impact of recruitment efforts to achieve proportional parity in the medical school class with the rural population of the state. Addressing rural physician workforce needs will require multiple strategies that affect different parts of the medical education and healthcare systems, including boosting college completion rates in rural areas. This model of analysis can also be applied to other pipeline programs to document the success of the recruitment efforts.
Highlights
Rural populations have poorer health outcomes and higher mortality rates [1], stemming from lack of health insurance coverage, health behavior and risk factors, lower socioeconomic status, and physician shortages in rural areas [2,3]
Between 2017 and 2019, 9.3% (n = 225) of University of North Carolina’s School of Medicine (UNC SOM) applicants were from a rural county
An increase of just 14 additional rural applicants annually would bring the proportion of rural UNC SOM applicants in alignment with the potential applicant pool in rural North Carolina (NC) counties
Summary
Rural populations have poorer health outcomes and higher mortality rates [1], stemming from lack of health insurance coverage, health behavior and risk factors, lower socioeconomic status, and physician shortages in rural areas [2,3]. Over the past four decades, even though the physician supply of North Carolina (NC) has grown, the maldistribution of physicians in urban versus rural areas has increased [4,5]. In 1979, urban counties had about 6.1 more physicians per 10,000 population compared to rural counties. Rural students are underrepresented in medical schools nationwide and their numbers are declining [6]. Because growing up in a rural area is a strong predictor of future rural practice [7,8,9,10,11,12], recruiting rural medical school applicants is an important strategy to boost the rural physician workforce. Some studies indicate rural applicants are likely to be admitted to medical school relative to urban applicants [6,15]. The medical school implemented pipeline programs to recruit more rural students.
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